LAUSR

tps://doi.org/10.1016/j.jds.2021.05. 91-7902/a 2021 Association for Denta e CC BY-NC-ND license (http://creati To manage the exposed bone in the surgery of medicationrelated osteonecrosis of the jaw (MRONJ), coverage methods using various local flaps have been developed; however, each flap has inherent limitations with respect to both coverage area and aesthetic results. Here, we reported our experience using a superiorly-based facial artery musculomucosal (FAMM) flap to overcome these shortcomings in reconstructing the maxillary defect of stage 3 MRONJ. An 81-year-old female with stage 3 maxillary MRONJ was referred to our department from her local hospital. She had been taking denosumab 60 mg/6 months for osteoporosis for 24 months. Intraoral examination revealed mucosal swelling and fistulae with exposed bone and purulent discharge in the left anterior area of the maxilla (Fig. 1A). In the surgical treatment, the teeth and the necrotic bone were completely removed, causing a large defect in the anterior area of the maxilla (Fig. 1B). The superiorly-based FAMM flap was designed to cover the trajectory of the facial artery from the gingivolabial sulcus of the second premolar to the level of the ipsilateral retromolar trigone with 7e9 cm length and 2e3 cm width